SCAPULAR WINGING DUE TO LONG THORACIC NERVE NEUROPATHY DETECTED WITH HIGH-RESOLUTION MR NEUROGRAPHY

Authors

Georgia Papagiannopoulou Attikon University Hospital
Aikaterini Theodorou
Vasiliki Zouvelou
Maria Ioanna Stefanou
Christos Moschovos
Georgios Velonakis
Marianna Papadopoulou

Keywords:

scapular winging, long thoracic nerve, neuropathy, magnetic resonance neurography

Abstract

Background: Scapular winging may be caused by palsies of long thoracic, spinal accessory or dorsal scapular nerves, leading to serratus anterior, trapezius or rhomboid muscles weakness respectively.

Methods: We report a case of scapular winging due to long thoracic nerve neuropathy.

Case report: A 23-year-old woman with unremarkable medical history presented with 6-month history of right shoulder pain and weakness. Neurologic examination revealed scapular protraction and upward rotation impairment associated with medial displacement of the right scapula. Nerve conduction study showed decreased compound muscle action potential (CMAP) amplitudes exclusively over the right serratus anterior, without acute denervation of the muscle. High resolution Magnetic Resonance Neurography (MRN) disclosed T2-weighted short-tau inversion recovery (STIR) diffuse hyperintense signal across the long thoracic nerve without gadolinium enhancement. Approximately nine months following symptoms onset and intensive physiotherapy, neurological examination revealed complete symptom resolution.

Conclusion: This case highlights the high resolution MRN utility, as promising and versatile technique on detecting isolated long thoracic nerve palsy in patients with scapular winging.